Leukemia Flashcards
What is leukemia?
Blood cancer that results from a loss of normal cellular regulation leading to uncontrolled production of immature WBCs in bone marrow
What can leukemia progress to?
myelodyplastic syndromes (MDs) = all patients have a decrease in all circulating blood cell types
What does leukemia lead to?
Anemia, thrombocytopenia, leukopenia
How is leukemia classified?
By cell types
-lymphocytic
-myelocytic
-biphenotypic leukemia (both types combined)
What is acute leukemia?
Sudden onset, rapid growing, more severe symptoms, bone marrow produces immature WBCs
-needs immeidate tx
What is chronic leukemia?
Slow onset, persists for months to years
-slow growing, usually milder symptoms
-bone marrow produces more mature cells (not fully developed)
-may not require immediate tx
What puts someone at risk for leukemia?
radiation, viral infection, exposure to chemicals & drugs, genetic factors, immunity factors
What assessment history do you need to gather?
RF
genetic factors
age
occupation
hobbies
medical hx- medications & radiations
infections
bleeding issues
weakness
fatigue
What does leukemia affect?
All organs and systems
How does it impact the CV system?
tachycardia
HYPOtension
slow capillary refill
murmurs
bruits
**HYPO and tachy due to anemia since the blood is thin so not a lot of O2 = decreased perfusion
What happens when WBC is high?
blood is THICCCK = HYPERtension with bounding pulses
How does it impact the respiratory system?
tachypnea
infiltrates
respiratory infection
What are the signs of respiratory infection?
cough
dyspnea
abnormal breath sounds
How does it impact the integumentary system?
pallor
cool
petechiae
poor healing wounds
bleeding gums
How does it impact the GI/GU system?
weight loss
nausea
anorexia
rectal & GI bleeding
decreased bowel sounds
liver enlargement
spleen enlargement
aBdominal pain/tenderness
hematuria
How does it impact the CNS?
cranial nerve changes
headache
seizure
papilledema
coma
fatigue
fever
behavior changes
somnolence
reduced attention
How does it impact the MS?
bone pain
joint swelling & pain
muscle weakness
What types of patients have a poorer prognosis?
Patients with a high immature WBC count at diagnosis
Whats another sign of leukemia?
lymph node enlargement
How do the labs appear?
Hemoglobin & hematocrit = low
platelet count = low
WBC= low, normal or high
reduced level of clotting factor
aPTT = prolonged
thrombocytopenia
Normal hematocrit
Normal hemoglobin
Normal platelet count
Normal WBCs
How to diagnosis leukemia?
bone marrow aspiration & biopsy
chromosome analysis (cytogenic studies)
imaging- x-ray/ bone density
Interventions for infection
infection prevention
drug therapy for infection
antibiotic prophylaxis
pulmonary hygiene
specialized unit
handwashing
aesptic technique
skin care
ensure those who enter the room are not sick
neutropenic precautions
What needs to be assessed to make sure no infection and sepsis?
-CBC with diff - WBC, Absolute neutrophils
-respiratory assessment
-assess urination & urine
-VS with temp
What are the 3 distinct phases of drug therapy for acute leukemia?
induction, consolidation, maintenance
What happens during induction?
combo chemo- 7 plus 3
What are the complications that can occur during induction?
infection, kidney/liver/cardiac toxicity, NVD, stomatitis, alopecia
What is more common during the induction phase?
infection related deaths
What happens during the consolidation phase?
another round of chemo
-occurs only in remission
What happens during the maintenance phase?
months to years after induction & consolidation
What is first line drug therapy for chronic leukemia?
Imatiruib mesylate (Gleevac)
